Nutrition Flashcards
nutrition
- Sum of all interactions between and organism and the food it consumes
- whole process till it gets to the large intestine
- Nutrients
– Carbohydrates: preferred energy source
– Fats: body burns this up
– Protein: burns up too. also used as a building block for new tissue
– Water
– Minerals
– Vitamins - need enough fluid intake to absorb and take in nutrients
metabolism
- All biochemical and physiologic processes by which body
– Grows and maintains itself
– Breaks down & reshapes tissue
– Produces heat - body is in a constant state of repair and growth
factors that affect on nutrition/metabolism: age
- Infant– Double birth weight at 4-5 months, triple at 1 year
- Breast milk or formula until 4-6 months of age
- Adolescent– Increase calorie needs, increased protein needs
- 45-55 Gm of protein/day
- Adult—Need 0.8 g of protein/ kg of weight
- Increased needs in pregnancy, lactation
o 300 more Kcal in pregnancy/ 500 in lactation
o Protein-10g/ day more in Pregnancy, 20g/day in lactation
- Increased needs in pregnancy, lactation
- Older Adult
- Less taste acuity, less efficient digestion
- decreased tissue sensitivity to insulin
- decreased somatotropin secretion–> ↓ protein synthesis
factors that affect on nutrition/metabolism: gender
- Men have higher caloric requirements than women
- Men have higher BMR due to larger muscle mass
factors that affect on nutrition/metabolism: climate
Affects heat production–colder climate increases BMR
factors that affect on nutrition/metabolism: activity/rest
- ↑ activity–>↑ metabolic rate–>↑ need for nutrients
- Metabolic rate, digestion rate drops during sleep
- Shivering increases metabolic rate
factors that affect on nutrition/metabolism: illness
- ↑ metabolic needs–>↑ need for nutrients
- Some illnesses affect ingestion, digestion & absorption of nutrients
–diseases of GI tract - Metabolic rate ↑ with fever
- Alteration in thyroid hormone affects metabolic rate; diabetes affects insulin production
- Some illnesses require individual to alter usual nutrition pattern
factors that affect on nutrition/metabolism: SES
Affects nutrient intake–what eaten, how much and how often
factors that affect on nutrition/metabolism: ethnicity and culture
- Affects food preferences
- Affects food preparation preferences
- See P&P, p. 1182 Box 45.5
factors that affect on nutrition/metabolism: religion
- May influence food eaten—see P&P. p. 1182, Table 45.3
- May influence when food eaten–fasting, abstinence
factors that affect on nutrition/metabolism: personal factors
- Affects food preferences/ dislikes
- Affects beliefs about diet & nutrition
- Lifestyle may affect type of food eaten
- Stress ↑ metabolic needs–may alter nutrient intake
- Peer groups/ advertising can influence food selection
factors that affect on nutrition/metabolism: medications/drugs
- Alcohol–provides calories but ↓ nutrients. ↑ need for B vitamins
- Can alter appetite & taste sensation
- Nutrient intake can affect drug absorption (See P&P, p. 1181)
cultural aspects of care
- Different cultures have different beliefs about food that should be eaten while sick
- Beliefs about hot/cold foods
- Open communication with client and family regarding food preferences
- Support food preferences whenever possible
- Box 45.5 pg 1182 (Potter and Perry)
nursing history
- Eating Patterns & habits
- Diet followed at home
- rephrase to what kind of foods do you eat
- might work night shift and eating dinner at 8 am is diff than eating at 8 pm
- Food allergies/ preferences/dislikes
- Difficulty eating/ swallowing
- Weight change in last 2 weeks/ last 3 months
- was it intentional? if not it could be a disease process
- Nutritional supplements (protein powder, shakes)
- Medications taken/ Alcohol use
- some meds need to be taken at certain times
- Ability to obtain, store & prepare food
- Usual Physical activity
mini nutritional assessment
- tests if older adults are at risk for malnutrition
physical assessment
- Inspect hair, skin, mucous membranes
- poor nutrition = could have rough hair, bruising on skin, mucous membranes may have started to break down
- Muscle tone, reflexes
- protein is key for muscles
- Condition of mouth/ teeth
- Height and weight
– Ideal body weight
– Weight change
* Significant loss
– 1-2% in a week, 5 % in a month, 7.5% in 3 months, 10% in 6 months
ideal body weight formula
- males: 106 + 6lbs for each inch over 5ft
- females: 100 + 5lbs for each inch over 5 ft
weight change
- amt of weight change/usual weight times 100
BMI
- obesity is classified over 30
- someone w/ a higher BMI does not always mean poor health
physical assessment: anthropometric measurements
– Skin fold measurement indicates amount of stored body fat
physical assessment: temperature
- measure of metabolism
- fever = speed up metabolic process
hemoglobin/hematocrit
- hemoglobin: tells us about iron
- low iron = low hemoglobin
- hematocrit: dehydration
- high hematocrit = dehydrated
serum albumin
- tells us abt protein in bloodstream
- normal: 3.5-5.5
- very long half-life of abt 20 days
- level will tell you abt nutritional status over the last 3 weeks
cholesterol
- ideal = less than 200
- HDL (good cholesterol)
- > 45 (male) >55 (female)
blood glucose (FBS)
- fasting blood sugar
- 70-110 for normal debut level
impaired nutritional intake (imbalanced nutrition NANDA)
– Definition— A decrease in the amount of food and nutrients ingested
– Patient can NOT be NPO
- are able to eat
- NANDA: intake of nutrients is insufficient to meet metabolic demands
overweight (obesity NANDA)
– A person’s body weight greater than what is considered healthy in relationship to their height, usually more than 20% over ideal weight
- NANDA: condition in which an individual accumulates abnormal or excessive fat for age and gender that exceeds overweight
nonadherance (risk prone health behavior NANDA)
- Being unable or unwilling to follow treatments and recommendations to promote personal health and well-being
impaired swallowing
- Difficulty or inability to move food from the mouth to the stomach via the esophagus
sedentary lifestyle
- not being active
projected outcomes
- Nutritional status
– Food & fluid intake
– Body mass index
– Weight/biochemical measures - Weight control
– Demonstrates progress toward target weight
– Balances exercise with caloric intake
– Maintains recommended eating patterns
nursing interventions
- Educate individual/ family about dietary needs in special situations
- Infancy/ childhood: need a lot of iron, calcium, and protein for brain development, body development, bones
- Pregnancy/ lactation: need a lot of folate, vit B6, extra 300 calories a day and 500 for lactation
- Wound healing: need protein, Vit C, and zinc
- bigger the wound = the more they’ll need
- Vegetarian diets: need to meet protein, iron, and vit b12(!!) requirements
provide client w/ appropriate diet
– Alteration in form
* Clear Liquid –> jello, broth, clear soda
– Liquid, see through at room temperature
* Full Liquid
– Liquid at room temperature
- can’t see thru it. milkshakes, pudding, cream soups
* Soft
– Soft in texture, low in residue, easily digested
– Mechanical soft—easily chewed –> ground turkey or chicken
– Pureed—baby food consistency
– Alteration in content
* Low sodium, high protein, ADA (american diabetic association) diet, etc
nursing interventions: target appetite
– Oral hygiene –> pts who can’t get up and brush their teeth struggle w/ this
– Minimize fatigue
– Frequent small feedings
– Treat pain & nausea
– Minimize psychological stress
– For individual with obesity—behavior modification
> modifying mindless eating habits
assist with eating
– Assist with set-up of tray/ foods
– Orient patient to position of food on plate
- most don’t want to be fed
- if you do feed them talk to them
diet supplementation
– Vitamins –> might be supplemented thru an IV or orally
– Nutritional supplements
– Obesity—Low calorie snacks
– Tube feedings
– Total parenteral nutrition (TPN)
* All necessary nutrition (except fiber) provide by
collaborate with others to promote nutrition
– Physician
– Dietician: how to improve the diet and how to get the nutrients they need
– Social worker: set up and help out w/ comm resources
– Speech therapist: deal w/ swallowing
– Occupational therapist: work w/ extremities and upper body
- help them w/ how to cook, use utensils, feed themselves
nursing intervention classification
- Nutrition management
- Nutritional counseling
- Weight management
- Nutrition monitoring
evaluation
- Patient weight__________
- Serum albumin level _____________
- Patient/ family able to describe appropriate diet ___________
- Food diary
WHICH OF THE FOLLOWING CLIENTS MAY BE EXHIBITING SIGNS OF A POOR NUTRITIONAL STATUS?
A. Billy White, whose hair is shiny and neither dry or oily.
B. Nella Green, whose skin is dry & rough with a few bruises. (CORRECT)
C. Mrs. Black, whose tongue and mucous membranes are pink and moist.
D. Mr. Brown, whose albumin level is 4.2 g/dl.
Mrs. G, a 42 year old Mexican-American patient, refuses to eat the hospital prepared food and eats only the flour tortillas, beans and rice brought in by her family. The nurse’s first action should be to
A. Determine whether Mrs. G’s diet meets her daily nutritional needs. (CORRECT)
B. Find out how to add meat to her diet for necessary protein intake.
C. Tell Mrs. G that the hospital prepares balanced meals and it would be better for her to eat what is on her tray.
D. Explain to Mrs. G how she can choose items of preference from the hospital menu.
WHICH OF THE FOLLOWING ARE ALLOWED ON A FULL LIQUID DIET. SELECT ALL THAT APPLY.
A. Scrambled eggs
B. Chocolate pudding (correct)
C. Tomato juice (correct)
D. Mashed potatoes
E. Cream of Wheat cereal (correct)
The patient is asking the nurse about the best way to stay healthy. The nurse explains to the patient that from a nutritional point of view, the patient should (Select all that apply.)
A. Maintain body weight in a healthy range. (CORRECT)
B. Increase physical activity.
C. Increase intake of meat and other high-protein
foods.
D. Keep saturated fat intake to 10% or less. (CORRECT)
E. Choose and prepare foods with little salt. (CORRECT)
Which statement made by a parent of a 2-month-old infant requires further education?
A. I’ll continue to use formula for the baby until he is a least a year old.
B. I’ll make sure that I purchase iron-fortified formula.
C. I’ll start feeding the baby cereal at 6 months.
D. I’m going to alternate formula with whole milk starting next month. (CORRECT)
- start whole milk at a year
